Correlation between hypotension during dobutamine myocardial perfusion imaging and severity of stress-induced ischemia

Document Type : original articles

Authors

1 Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Hazrate Rasule Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran

Abstract

Objectives: An accurate non-invasive evaluation of coronary artery disease (CAD) is essential in choosing the right management plan. Dobutamine stress myocardial perfusion imaging (MPI) is a substitute test for patients who cannot exercise. This study aimed to assess the relationship between dobutamine-induced hypotension and risk stratification of annual hard cardiac events evaluated by MPI.
Methods: This study is a retrospective study conducted on 1004 patients from October 2015 to august 2019.These patients referred to Rasoul Akram Hospital, because they could not exercise electrocardiography or had contraindications to vasodilator therapy, they were subjected to dobutamine Tc99m-Sestamibi single photon emission tomography (SPECT) protocol. During the protocol, blood pressure was measured with a one-minute interval.  From among the participants, 247 patients had decreased blood pressure by more than 20 mmHg during infusion. Then for patients, a gated MPI scan was performed, and  MPI with a quantitative and visual interpretation determined the risk stratification of the patients. Multivariable logistic regression model assessed the associations between decrease in blood pressure (above 20 mmHg) and risk stratification.
Results: A total of 1004 patients with a mean age of 59.07 years were studied. Of these patients, 247 had > 20mmHg drop in systolic BP from baseline. This study revealed a significant correlation between hypotension during the dobutamine stress test and high-risk scan patterns in myocardial perfusion scan. Moreover, there was a significant correlation between age increase, smoking, diabetes mellitus, transient ischemic dilation (TID), high baseline blood pressure, and history of CABG or angioplasty with a high-risk scan pattern in MPI.
Conclusions: This study demonstrated that hypotension during the dobutamine stress test is correlated with high-risk scan patterns in MPI.

Keywords

References

1.Malek H, Hedayati R, Yaghoobi N, Behnia M, Rastgou F, Bitarafan Rajabi A, et al. The relationship between retinopathy in diabetes mellitus type 2 and severity and extent of myocardial ischemia in myocardial perfusion imaging.  Iranian Heart 2013;13(4):6-14.
2. Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 1999; 33(7):2092-197.
3. Lee J, Chae SC, Lee K, Heo J, Iskandrian AS. Biokinetics of thallium-201 in normal subjects: comparison between adenosine, dipyridamole, dobutamine and exercise. J Nucl Med. 1994; 35(4): 535-41.
4. Malek H, Hedayati R, Yaghoobi N, Firoozabadi H, Rastgou F, Bitarafan Rajabi A. Association Between Blunted Heart Rate Response to Dipyridamole and Myocardial Ischemia in Diabetic Patients as Compared With Nondiabetic Patients. Iranian Heart . 2020; 21(1):67-74.
5. Schinkel AF, Elhendy A, Van Domburg RT, Bax JJ, Vourvouri EC, Sozzi FB, et al. Prognostic value of dobutamine-atropine stress myocardial perfusion imaging in patients with diabetes. Diabetes Care. 2002; 25(9):1637-43.
6. Pennell DJ, Underwood SR, Ell PJ. Safety of dobutamine stress for thallium-201 myocardial perfusion tomography in patients with asthma. Am J Cardiol. 1993; 71(15):1346-50.
7. Dakik HA, Vempathy H, Verani MS. Tolerance, hemodynamic changes, and safety of dobutamine stress perfusion imaging. J Nucl Cardiol. 1996; 3(5):410-4. 
8. Elhendy A, Valkema R, van Domburg RT, Bax JJ. Safety of dobutamine-atropine stress myocardial perfusion scintigraphy. J Nucl Med. 1998; 39(10):1662-6.
9. Geleijnse ML, Elhendy A, Fioretti PM, Roelandt JR. Dobutamine stress myocardial perfusion imaging. J Am Coll Cardiol. 2000; 36(7):2017-27. 
10. Rallidis LS, Moyssakis IE, Nihoyannopoulos P. Hypotensive response during dobutamine stress echocardiography in coronary patients: A common event of well‐functioning left ventricle. Clin Cardiol. 1998; 21(10):747-52. 
11. Tanimoto M, Pai RG, Jintapakorn W, Shah PM. Mechanisms of hypotension during dobutamine stress  echocardiography in patients with coronary artery disease. Am J Cardiol. 1995; 76(1):26-30. 
12. Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol. 2016; 23(3):606-39. Journal of Nuclear Cardiology. 2016;23(3):606-39.
13. Malek H, Samiei N, Yaghoobi N, Bavaghar N, Firoozabadi H, Rastgou F, et al. Assessment of LV diastolic dysfunction in myocardial perfusion imaging: a correlative study with transthoracic echocardiography. Nucl Med Commun. 2021; 42(9):979-983. 
14. Dorbala S, Ananthasubramaniam K, Armstrong IS, Chareonthaitawee P, DePuey EG, Einstein AJ, et al. Single photon emission computed tomography (SPECT) myocardial perfusion imaging guidelines: instrumentation, acquisition, processing, and interpretation. J Nucl Cardiol. 2018; 25(5):1784-1846. 
15. Bitarafan-Rajabi A, Rastgou F, Hosseini S, Firoozabadi H, Malek H, Amouzadeh H, et al. Assessment of myocardial viability in patients with left ventricular dysfunction: Correlation between CT-based attenuation correction and uncorrected quantification analysis in thallium201 (201Tl) rest-redistribution SPECT study. Iranian Heart J. 2013; 13(4): 15-20.
16. Wang C-H, Cherng W-J, Hung M-J. Dobutamine-induced hypotension is an independent predictor for mortality in patients with left ventricular dysfunction following myocardial infarction. Int J Cardiol. 1999; 68(3):297-302. 
17. Geleijnse ML, Elhendy A, van Domburg RT, Rambaldi R, Reijs AE, Roelandt JR, et al. Prognostic significance of systolic blood pressure changes during dobutamine-atropine stress technetium-99m sestamibi perfusion scintigraphy in patients with chest pain and known or suspected coronary artery disease. Am J Cardiol. 1997; 79(8):1031-5. 
18. Elhendy A, Bax JJ, Poldermans D. Dobutamine stress myocardial perfusion imaging in coronary artery disease. J Am Coll Cardiol. 2000; 36(7):2017-27. 
19. Day SM, Younger JG, Karavite D, Bach DS, Armstrong WF, Eagle KA. Usefulness of hypotension during dobutamine echocardiography in predicting perioperative cardiac events. Am J of Cardi. 2000;85(4):478-83.
20. Dhond MR, Whitley TB, Singh S, Nguyen TT, Bommer WJ. Incidence and significance of profound hypotension during dobutamine stress echocardiography. Clin Cardiol. 2000; 23(1):47-50. 
Cardiovascular Biomedicine
Volume 2, Issue 1
September 2022
Pages 29-35

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History

  • Receive Date: 08 November 2021
  • Revise Date: 27 January 2022
  • Accept Date: 04 February 2022

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